Basic Information
| Provider Information | |||||||||
| NPI: | 1255368619 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARRISON'S HOPE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARRISON'S HOPE . . . A CARING HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3137 S MERIDIAN RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836427088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089476800 | ||||||||
| FaxNumber: | 2089476806 | ||||||||
| Practice Location | |||||||||
| Address1: | 3137 S MERIDIAN RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836427088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089476800 | ||||||||
| FaxNumber: | 2089476806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 06/28/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARTWAY | ||||||||
| AuthorizedOfficialFirstName: | KRISTI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS & COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 2089476800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 807590700 | 01 | ID | MEDICAID PROVIDER NUMVER | OTHER |